Provider Demographics
NPI:1144319047
Name:KEROSON, ROBERT E (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:KEROSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-0206
Mailing Address - Country:US
Mailing Address - Phone:803-635-3211
Mailing Address - Fax:803-635-6460
Practice Address - Street 1:143 U.S HWY 321
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-0206
Practice Address - Country:US
Practice Address - Phone:803-635-3211
Practice Address - Fax:803-635-6460
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH0869Medicaid
SCT25057Medicare UPIN
SCCH0869Medicaid